A Lattice-Tip Temperature-Controlled Radiofrequency Ablation Catheter: Durability of Pulmonary Vein Isolation and Linear Lesion Block

Vivek Y. Reddy*, Petr Neužil, Petr Peichl, Gediminas Rackauskas, Elad Anter, Jan Petru, Moritoshi Funasako, Kentaro Minami, Audrius Aidietis, Germanas Marinskis, Andrea Natale, Hiroshi Nakagawa, Warren M. Jackman, Josef Kautzner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: This study was designed to evaluate lesion durability on invasive electrophysiologic remapping. Background: The lattice-tip catheter generates a large thermal footprint during temperature-controlled irrigated radiofrequency ablation. In a first-in-human study, this catheter performed rapid point-by-point pulmonary vein isolation (PVI) and other linear atrial ablations. Methods: In a prospective 3-center single-arm study, paroxysmal or persistent atrial fibrillation patients underwent PVI and, as needed, linear ablation at the cavotricuspid isthmus (CTI), mitral isthmus (MI), and/or left atrial roof; no other atrial substrate was ablated. Using the lattice catheter and a custom electroanatomic mapping system, temperature-controlled (Tmax 73° to 80°C; 2 to 7 s) point-by-point ablation was performed. Patients were followed for 12 months. Results: A total of 65 patients (61.5% paroxysmal/38.5% persistent) underwent ablation: PVI in 65, MI in 22, left atrial roof in 24, and CTI in 48 patients. At a median of 108 days after the index procedure, protocol-mandated remapping was performed in 27 patients. The pulmonary veins (PVs) remained durably isolated in all but 1 reconnected PV—translating to durable isolation in 99.1% of PVs, or 96.3% of patients with all PVs isolated. Of 47 linear atrial lesions initially placed during the index procedure, durability was observed in 10 of 11 (90.9%) MI lines, all 11 (100%) roof lines, and all 25 (100%) CTI lines. After a median follow-up of 270 days, the 12-month Kaplan-Meier estimate for freedom from atrial arrhythmias was 94.4 ± 3.2%. Conclusions: Temperature-controlled lattice-tip point-by-point ablation showed not only highly durable PVI lesion sets, but also durable contiguity of linear atrial lesions.

Original languageEnglish
Pages (from-to)623-635
Number of pages13
JournalJACC: Clinical Electrophysiology
Volume6
Issue number6
DOIs
StatePublished - Jun 2020
Externally publishedYes

Funding

FundersFunder number
Affera Inc.
Affera, Inc.
EPIX
Epix Therapeutics
MicroPort CRM
Boehringer Ingelheim
Abbott Laboratories
Bayer
Medtronic
St. Jude Medical
Biosense Webster
Boston Scientific Corporation
Merck Sharp and Dohme
LivaNova
Daiichi-Sankyo
Biotronik

    Keywords

    • atrial fibrillation
    • catheter ablation
    • cavotricuspid isthmus
    • lattice-tip
    • lesion durability
    • mitral isthmus
    • pulmonary vein isolation
    • roof line
    • temperature-controlled

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